Sleep-Associated Torsades de Pointes: A Case Report

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Torsades de Pointes (TdP) is a polymorphic ventricular tachycardia that occurs in the presence of anacquired or congenital long QT syndrome (LQTS). We present the case of a 57 year-old man withend-stage renal disease on methadone maintenance in which there occurred multiple episodes of TdPduring sleep. The patient was found to have a QTc interval of 548 milliseconds, and the dysrhythmiawas successfully treated with isoproterenol infusion and methadone substitution. It is surmised that thepatient had a multifactorial, acquired LQTS that during somnolence, reached a critical threshold of QTprolongation to lead to the development of TdP.